Early Endoscopic Ventricular Irrigation for the Treatment of Neonatal Posthemorrhagic Hydrocephalus: A Feasible Treatment Option or Not? A Multicenter Study

Abstract

Aim: Neonatal intraventricular hemorrhage (IVH) usually results in posthemorrhagic hydrocephalus (PHH). This multicenter study describes the approach of early neuroendoscopic ventricular irrigation for the treatment of IVH/PHH and compares the results with the cases that have been initially treated only with conventional temporary cerebrospinal fluid (CSF) diversion techniques.

Material and methods: The data of 74 neonatal PHH cases, that have been treated at three pediatric neurosurgery centers, were retrospectively analyzed. 23 neonates with PHH underwent early endoscopic ventricular irrigation (Group-A). 29 neonates were initially treated with conventional methods (Group-B). 22 neonates underwent ventriculosubgaleal shunt placement (Group-C). Complications, shunt dependency rates, incidence of multiloculated hydrocephalus and incidence of CSF infection were evaluated and compared retrospectively.

Results: Group-A, Group-B and Group-C cases did not differ significantly regarding gestational age and birth weight. In Group-A, 60.8% of the patients required a later shunt insertion, as compared with 93.1% of the cases in Group-B and 77.2% of the cases in Group-C. Group-A patients were also associated with significantly fewer CSF infections as well as significantly lower incidence for multiloculated hydrocephalus development as compared with Group-B and Group-C.

Conclusion: Early removal of intraventricular blood degradation products and residual hematoma via neuroendoscopic ventricular irrigation is feasible and safe for the treatment of PHH in neonates with IVH. Neuroendoscopic technique seems to offer significantly lower shunt rates and fewer complications such as infection and development of multiloculated hydrocephalus in those cases.